Part 14: Episode 14: Blazing Darkness

This update covers:

Gabriel Cunningham 3 - Blazing Darkness (part 1 of 2)*

*Technically, this episode takes place before "Marionette's Lament." I placed it here because I felt it flowed better, but Tomoe will show up later on, so I figure I need to mention it here.

Blazing Darkness: Intro




Tillman: You fool! How dare you force me into this hospital!

Gabe: What a pain in the... Let's begin the exam, RONI. Why don't you start by telling me what symptoms you're experiencing?

Tillman: I'm not saying anything, you jackanape!

Gabe: Well, go right ahead if you don't ever want to be discharged from this hospital.

Tillman: You utter bastard. Fine! Ask your questions!



Tillman: Yes, I collapsed, but I simply wasn't feeling well. I'm not as young as I used to be, and I've been under quite a lot of stress. There's so much to be done, and you're not helping! Quit wasting my time and issue my release! ............... Dammit, you're never going to give up, are you? Being stuck in this stinking examination room is killing my appetite. Honestly, I haven't eaten much, but I feel queasy and bloated. So what!? It doesn't matter! Just sign your little forms and discharge me! Looking at your stupid face makes me even more nauseous!

There were a good few in there, but a lot of them are not entirely obvious. The first is the part where he says he'd under stress.



Gabe: Serves him right. I'm exhausted just having to deal with him. Isn't that right, RONI?

RONI: I do not share your pain, doctor. New symptom: "Gets Tired Easily".

That's a bit of a leap, but hey. The next one is a lot easier: he mentioned having no appetite, and his crack about the room isn't too believable.

Gabe: His appetite's been decreasing. Maybe he's been trying some of the food here. RONI, I want you to make a note of the patient's appetite. Also, jot down that the hospital food sucks.

RONI: I must remain professional, Doctor. New symptom: "Lack of Appetite."

He also mentioned being "queasy and bloated."

Gabe: That's not to say he isn't already on the chunky side. RONI, order a CT scan, and warn the lab guys that they may need a forklift to get him on the table.

RONI: I will send the request at once. I may use a slightly different wording for the second part.

Tillman: Hey, you! You don't need to examine me! I refuse this treatment!

Gabe: If we don't look in your stomach, we'll never know what's wrong with you.

Tillman: If you think it's necessary, then prove it!

RONI: Doctor, all examinations require patient consent.

Tillman: You're as stubborn as he is, you know that? Fine, I'll just narrow down the diagnosis candidates and prove an exam is necessary.

RONI: That is standard protocol, Doctor. New Symptom: "Bloated Abdomen."

Finally, Tillman said something about feeling "even MORE nauseous." This seems like a repeat of the last one, but it isn't.

Gabe: That means he was already feeling nauseous before me came here. How's THAT for deduction?

RONI: New Symptom: "Nausea."

That's enough of that. Tillman won't let you get under his shirt, with a stethescope or otherwise, so we move on to the diagnostics numbers.



This is one of the medal challenges for this chapter. You're unlikely to find this one without the hint, which means you probably won't have it upon first completing the game.

Gabe: Look, RONI! Three sevens!

RONI: Doctor, is this abnormal?

Gabe: ...No. *sigh* Nevermind.

That was his white cell count, if you're curious. It doesn't really matter, though. Anyway, the following numbers are off:

Platelet Count: A count of platelets responsible for hemostasis in the blood. Can indicate blood, liver, or viral disorders. Normal level is 15 ~ 35. Measured level is 8.0

Gabe: It seems unusually low. Add that to his records.

RONI: Understood. New symptom: "Low Platelet Count."

Total Bilirubin: A pigment formed when hemoglobin is broken down. An accumulation of this in the body results in jaundice. Normal level is 0.2 ~ 1.0. Measured level is 2.1.

Gabe: It seems rather high. RONI, make a record of that.

RONI: New symptom: "High Total Bilirubin Level."

Gabe: If it's this high, he should have jaundice in the whites of his eyes. The problem is that that geezer's eyes are too squinty for me to examine. Somehow, I doubt he'll cooperate and let me look.

RONI: Doctor, perhaps you could try angering the patient? I have noticed that Chief Patel's eyes are frequently wide open when conversing with you. It is a physiological response in humans to open their eyes wider when angry.

Gabe: You're pretty observant, aren't you? I don't know if I like the example you gave, but I'll try your tactic.

We'll finish crunching these numbers, first.

AST: Aspertate Aminotransferase is found in the liver, myocardium, and skeletal muscles. When in blood, it indicates organ disorders. Normal level 10 ~ 40. Measured level 247.0

Gabe: His AST level is rather high. RONI, record it.

RONI: New Symptom: "High AST Level."

ALT: Alanine Aminotransferase is found in great quantities in the liver. When found in the blood, it indicates liver disorders. Normal level is 5 ~ 40. Measured level is 168.0

Gabe: That's pretty elevated. RONI, make a note of that.

RONI: New symptom: "High ALT Level."

Cholesterol: A compound made in the liver classified as a steroid used as cell membranes, hormones & bile acids. Causes arteriosclerosis. Normal level is 130 ~ 220. Measured level is 103.0.

Gabe: Interesting. It's unusually low. RONI, make a note of that, too.

RONI: New symptom: "Low Total Cholesterol."

We're done with the numbers for now, finally. These symptoms are definitely pointing towards a problem in the liver. It's a little odd to leave it for last, maybe, but we'll actually physically look at the patient now. I waited since we couldn't do the jaundice thing until you find it in the diagnostics.



This is like the shaking fingertips in that you can't really see them in stills, but I think it's also the last time you have to find something moving like that in an examination.

Gabe: His legs are still shaking. That's definitely worth making a note of.

RONI: New Symptom: "Shaking Legs."

Now, we need to get this jerk mad. I think we all know the most potent insult is a fat joke.



Gabe: Don't be ashamed. I'm not someone to judge a patient, no matter how fat they are.

Tillman: You son of a bitch! You can't talk to me like that!



This is really hard to see if you don't have a nice TV, let me tell you. Luckily, it's pretty safe to assume that it's there.

Gabe: Mark it down.

RONI: New Symptom: "Jaundice."

Alright, we have everything we can get at the moment. In order to get our sweet, sweet CT fix, we'll need to narrow down the candidates.



RONI: We should compare our symptoms to the possible illness candidates. If the likely candidates require a CT scan to be identified, then there is ample evidence to have one taken.

Gabe: Sounds good to me. Guess you're pretty useful sometimes.

RONI: Did you just impart genuine praise on me, Doctor?

Gabe: Hey, I give credit where it's due.



Symptoms List
Jaundice
Shaking Legs
Low Total Cholesterol
High ALT
High AST
High Bilirubin
Low Platelet Count
Nausea
Bloated Abdomen
Gets Tired Easily

Alright, let's check the candidates from the top.

Malignant Liver Tumor
A malignant tumor formed in the liver. The patient shows no subjective symptoms in the early stages. As the condition progresses, the patient will notice symptoms such as lack of energy, nausea, lack of appetite, and bloating of the abdomen, in addition to throbbing pain in the upper abdomen. Outward symptoms such as jaundice and shaking will appear as well. An analysis exam will detect an obviously high PIVKA-II level along with other abnormalities such as high total bilirubin level, high AST level, high ALT level, low total cholesterol level, and low platelet count. A CT exam of the abdomen will confirm a swollen liver and ascites accumulation. A scintigraphy will confirm... [snip]

Alright, this one is close. We're missing abdominal pain, but that's tricky with such an uncooperative patient. However, his PIVKA-II levels were fine. This isn't the proof we need.

Acute Hepatitis
A condition in which liver cells rapidly become inflamed due to multiplication of hepatitis viruses within the cells. Most patients complain of dull pain in the abdomen and nausea, as well as other symptoms such as lack of appetite and abdominal bloating. A visual exam may confirm jaundice, and as the liver inflammation progresses, symptoms such as a shaking of the extremities will appear. An analysis exam will note abnormalities such as high total bilirubin level, high AST level, high ALT level, and the virus antibody reaction will be positive. A CT [snip]

We found a lot of stuff on the analysis exam other than these, so this won't do the trick, either.

Congestive Liver Failure
A condition in which blood flow is prevented, causing blood to settle in the liver, causing problems in liver function. The patient tires easily and may exhibit nausea and lack of appetite. Symptoms may appear such as abdominal bloating, jaundice, and shaking. A blood analysis will reveal many abnormalities such as high total bilirubin level, high AST level, high ALT level, low total cholesterol and low platelet count. The liver may become swollen along with ascites accumulation due to the decrease in liver functions. This can be detected by a CT scan of the abdomen.

This one has everything we've found so far, and the only remaining symptoms require a CT to confirm.

RONI: The necessity for a CT scan is undeniable.

Gabe: Looks like our favorite patient's about to get a CT scan.



Tillman: What!?

Gabe: Hahaha... RONI, show him.

RONI: This is the record of the current diagnostic progress.

Gabe: And now, you need a CT exam. Is that alright with you, Mr. Assistant Secretary?

Tillman: No, you fool!

Gabe: Well, then let's hope to it! RONI, get us approval.

And we are allowed to use the CT scanner even though he actually didn't just consent. Whatever, I don't care.



RONI: The images are ready, Doctor. Please look over the results.

Gabe: Don't I get a break? I could have sworn we're supposed to have schedules break time...

If our results are correct, we should be looking for liver welling and ascites accumulation. Regardless, you just need to look for differences.

CT_01
Patient:


Sample:


CT_02
Patient:


Sample:


CT_03
Patient:


Sample:


Firstly, you can see in all three slides that the abdomen is larger than it should be. It's a bit more subtle than the other thing, which you almost certainly noticed with no issues, but it's quite visible in every image.



Gabe: RONI, make a note.

RONI: New symptom: "Swollen Liver."

Secondly, a big dark shadow can clearly be seen in the second slide.

Gabe: The color difference confirms that ascites has formed. This explains the bloated abdomen. RONI, write down this patient has a pool in his abdomen.

RONI: I will abbreviate that, Doctor. New Symptom: "Ascites Accumulation".

Those are the last two symptoms we needed, and there's nothing else to find. That means we can safely diagnose this patient with Congestive Liver Failure.





Gabe: It's common for this disease to be just a complication of something linked with heart failure.

RONI: Would you like to make a note of the Congestive Liver Failure and continue the diagnosis?

Gabe: Better safe than sorry. Let's continue the diagnosis. RONI, fill out the necessary paperwork.

It just now hit me how filling out annoying forms is basically the perfect use for an advanced AI.

RONI: Understood, Doctor. Please begin investigating the patient's primary disease.

Next time: Diagnosis part 2. What's the real problem with the Assistant Secretary?